Chest
Clinical InvestigationsPulmonary Hemodynamics in Advanced COPD Candidates for Lung Volume Reduction Surgery or Lung Transplantation
Section snippets
Materials and Methods
All COPD patients referred to our center for consideration of either LT or LVRS from 1988 to 2002 and who underwent right-heart catheterization were screened for potential inclusion in the study. Right-heart catheterization is not performed routinely for COPD but is a mandatory component of a thorough cardiorespiratory assessment before LT or LVRS.
Patients were excluded if a factor that could influence pulmonary hemodynamics was present. In particular, the exclusion criteria were as follows:
Characteristics of the Studied Population
Two hundred forty-seven patients fulfilled the selection criteria for the study. Although they had no evidence of cardiac dysfunction, 32 patients with a Pw > 15 mm Hg were excluded from the analysis because pulmonary hypertension, when present, has a postcapillary component. Thus, 215 patients form the basis of this study.
In this cohort, pulmonary hemodynamics was assessed as a preoperative evaluation before LVRS in 123 patients and before LT in 92 patients. The demographic and respiratory
Discussion
The salient results of our study are the following: (1) while half of the patients with severe COPD had mild-to-moderate pulmonary hypertension, a subset of patients (3.7%) exhibit severe pulmonary hypertension; and (2) we identified a subgroup of patients characterized by a moderate impairment of the pulmonary mechanics contrasting with the severity of pulmonary hypertension.
Pulmonary hypertension is a well-known complication of COPD. Its presence is associated with a worse survival11 and an
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